BOYNTON BEACH, Fla. – InteliSys Health announced RxStream Dynamic Pricing, a groundbreaking, patent-pending technology that dynamically analyzes, reprices and adjudicates pharmacy claims from drug discount card programs, SuperBin’s, and Pharmacy Benefit Manager (PBM) or carrier claims in real-time, increasing pharmacy margins and consumer savings.
In development for over a year and already integrated within leading pharmacy management systems, RxStream Dynamic Pricing helps pharmacies and consumers avoid the predatory admin fees and clawbacks that are built into drug discount cards, which cause consumers to unknowingly pay more than necessary for their medications. In fact, a 2022 InteliSys review of RxStream data from over 10,000 pharmacies revealed that the average admin fee/clawback on a discount card or SuperBin claim is $5.86 per prescription. Additionally, the review found that more than half of all prescriptions studied carried fees of $5 or more.
“Patients understandably want to save money on their prescriptions, but they are being fooled into thinking drug discount cards are the lowest-cost solution,” said Thomas Borzilleri, founder and CEO of InteliSys Health. “The discount card companies collect billions in admin fees and clawbacks while pharmacies make pennies on each transaction. RxStream strips out those costs and shares the savings with the pharmacy, increasing their margins and overall profitability while also providing medications to the consumer for less.”
First available in July 2022, RxStream has already been integrated into pharmacy management systems used by thousands of community and chain pharmacies across the U.S. BestRx was one of the first to integrate RxStream into its pharmacy management system, which is used by independent pharmacies nationwide. BestRx President Hemal Desai said the company’s pharmacy customers love the solution.
“When a pharmacy encounters a drug discount card with a high admin fee, the BestRx system automatically applies RxStream pricing so that the pharmacy is able to provide the patient with savings and gain a portion of the prescription costs that would otherwise have gone to the discount card company,” said Desai. “That’s not only great customer service but a bottom-line boost for pharmacies that have limited ways to increase their revenue because the PBM’s that administrate the discount card programs and insurance contracts dictate medication prices.”
How RxStream Works
RxStream is integrated into Pharmacy Management and Operating Systems through application programming interfaces (APIs). Working entirely in the background, the technology automatically analyzes every prescription claim processed by the pharmacy and, within fractions of a second, identifies the maximum margin for the pharmacy and savings for the customer, based on the consumer’s existing benefit plan/discount program. If RxStream identifies a mutually beneficial opportunity (for both the pharmacy and patient), it automatically adjudicates the claim.
When the consumer arrives at the pharmacy, RxStream provides an onscreen alert if a lower cost is identified. The pharmacy staff can then inform the customer of the savings opportunity and get their consent to forgo the drug discount program/carrier copay in favor of the lower cost.
Similarly to the admin fees applied to discount cards, PBMs embed clawbacks into the cash price a consumer pays for their prescription. These charges are the difference between the copay amount and the contracted reimbursement rate the carrier has with the pharmacy for that prescription. Typically, these clawbacks create a negative profit for the drug dispensed, which is a hardship for pharmacies already struggling to remain profitable.
To learn more about RxStream or to schedule a demo, visit https://www.intelisyshealth.com/contact/.